Health ministers from several African countries have vowed to tackle the high number of deaths of women due to unsafe and crude abortion by among other efforts, expanding the provision of safe abortion services.

The commitment was made by ministers of health and gender and senior government officials from Ghana, Liberia, Kenya, Malawi, Mali, Nigeria, Sierra Leone, Tanzania, Uganda and Zambia at a regional meeting of ministers on unsafe abortion and maternal mortality in Africa.

The meeting took place on June 18-19, 2013 in Nairobi, Kenya and Malawi was represented by the then deputy ministers of health and gender Halima Daud, and Agnes Mandevu Chatipwa respectively, Lastone Chikoti, the Reproductive Health Officer in the ministry of health and Elsie Tembo the Second Principal Secretary in the ministry of gender.

“We note that unsafe abortion constitutes between 13-30 percent of the unacceptably high rates of maternal deaths in our countries, and acknowledge that concrete and urgent action must be taken to address this challenge if maternal death and injuries are to be effectively reduced.

“We additionally recognize that unsafe abortion constitutes a violation of women’s human rights, and affirm the link between protection, promotion and realization of women’s human rights to the improvement of sexual and reproductive health outcomes for women and girls in our countries,” reads the communiqué by the minister in part.

The ministers mentioned other countries which are providing safe abortion services and simultaneously reduced their maternal mortality rates.

The ministers thus committed themselves to individually and collectively as countries tackle the problem by examining laws, using evidence to raise awareness on issue.

“We will try to integrate evidence and advocacy on the issue of unsafe abortion into the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) and in other efforts to reduce maternal mortality and morbidity in our respective countries.

“We will also encourage our governments to include the issue of unsafe abortion as part of the issue of maternal health in Cooperation Frameworks with donor countries and development partners,” said the ministers.

According to a 2010 ministry of health study called Abortion in Malawi: Results of a Study of Incidence and Magnitude of Complications of Unsafe Abortion, 70,000 Malawian women have abortions every year, which is 24 abortions for every 1000 women aged 15-44. 31,000 Malawian women are treated for complications of unsafe abortion annually.

Approximately 17 percent of maternal deaths in Malawi are attributable to unsafe abortion, making it one of the primary causes of maternal mortality. 30percent of all admissions in country’s gynecological wards are due to unsafe abortion.

The French law greatly expands access to abortions and also offers free and anonymous birth control to teenagers ages 15 to 18. France’s National Assembly passed the expansive abortion bill in October, and the legislation was approved by the Senate shortly thereafter.

The new law seeks to make abortion more easily attainable and offer free contraceptives to cut down on unwanted pregnancies. According to the French Directorate for Research, Studies, Evaluation and Statistics, 225,000 abortions were performed in France in 2010.

As Radio France Internationale notes, free access to birth control includes first and second generation contraceptive pills, along with contraceptive implants and sterilization. However, the law will not include other contraceptives, such as condoms.

Before the law was passed, France only offered to cover up to 80 percent of [the cost of] procedures to terminate pregnancies. Contraception costs were also partially refunded with reimbursements set at 65 percent. France provides remunerations for abortions and contraceptives through its social security funds.

Prohibiting the use of foreign aid to provide access to safe abortions has repercussions far beyond US borders

US aid policy still denies women access to abortion if they are raped in war. Photograph: Carolyn Kaster/AP

Over many years, I have visited conflict-affected states where I have met women who have suffered the agony of rape, and where sexual violence is the shocking and specific consequence of conflict.

These women are often traumatised, stigmatised and ostracised by their families and communities. When they are pregnant as a result of rape, these consequences are compounded.

While there is welcome attention focused on the plight of women and girls raped in war, there are still significant gaps in the international response to this global scourge.

One of those critical gaps is the routine denial of access to safe abortion services for rape survivors, which violates their rights under international humanitarian law. The reality is that these women are entitled under the Geneva conventions “to receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition”.

I remember meeting three women in the Democratic Republic of the Congo who had been gang-raped the day before as they walked home from the market. I will never forget them, and I have often wondered what would have happened if they were pregnant, because abortion is illegal in Congo .

What we do know is that, often when women in such situations are denied access to safe abortion services, they resort, in desperation, to unsafe methods that can result in serious harm or even death. And this happens even though several international bodies, including the committee against torture and the human rights committee, have found that the denial of abortion to rape victims can be defined as “torture and cruel, inhuman and degrading treatment”.

So what exactly are the obstacles and restrictions facing them, when it is already clearly defined that when rape is used as a weapon of war, in armed conflict, women have an absolute right to non-discriminatory medical care under the Geneva conventions?

ICRC is the Department for International Development’s (DfID) partner of choice and receives the largest amount of DfID funding made to humanitarian organisations. This means that the UK is severely compromised by restrictions that it apparently doesn’t support, and which allow for a situation where life-saving abortion is being denied, even to very young girls raped in conflict.

This clearly flies in the face of international humanitarian law. In a recent statement, DfID said: “In conflict situations where denying an abortion in accordance with national law would threaten the mother’s life or cause unbearable suffering, international humanitarian law principles may justify performing an abortion”.

Does that mean that when the suffering of an impregnated war rape victim is “bearable” she can be denied an abortion? And how does she prove that her suffering is unbearable?

DfID says it talks to Norway , a country that is showing real leadership and has asked the US to lift the abortion ban as a matter of compliance with the Geneva conventions. Why doesn’t the UK join Norway in the stand it is taking?

And isn’t it time that the UK stood up for the rights of women and girls who have been raped to have the same access to medical treatment as other war victims?

The French government announced in the last week of September 2012 that all terminations of pregnancy would be reimbursed in full by the Social Security insurance from 2013. The procedure will therefore be free of cost for women. This was a commitment made by François Hollande during the presidential election campaign in France earlier this year.

Each year in France, there are about 225, 000 abortions and 54% are medical abortions. The cost varies from 200 to 450 Euros, depending on the method and is currently reimbursed by the state at 70% for medical abortions and 80% for surgical abortions.

At a press conference on Friday at noon, Josep Carbonell, director of the Mediterranea Medica clinic in Valencia announced that the clinic is going on strike tomorrow Monday for one week, because for 7 months the regional administration has not paid for abortions provided to women referred by public hospitals who refuse to perform abortions. Because of the outstanding payments of €500,000, workers at the clinic have worked without pay for 4 months and suppliers cannot be paid either. During the strike, minimal services will be maintained so that women seeking abortions do not have to wait until they are over the legal time limits for abortion.

With the closure, the clinic also wants to protest against the intention to restrict the 2010 abortion law announced by the Minister of Justice Gallardon. Dr Carbonell warned that if Gallardon persists in these restrictive reforms and wants to force abortion back underground, he will launch: “a clandestine network of free clinics to ensure the rights of women. They will have to put many of us in jail ,” he said.

By Sarah Ditum

WeNews correspondent

Thursday, May 31, 2012

Polls show most U.K. citizens support a woman’s right to choose abortion. But U.S.-style anti-choice tactics are picking up speed and fostering an aggressive activism movement marked by website hacking and clinic vigils.

BATH, England (WOMENSENEWS)–The United Kingdom may be a pro-choice nation in polling data, but U.S.-style anti-choice tactics are being used to attack that consensus.

Seventy percent of U.K. citizens polledin 2011 said it was a woman’s right to choose whether she continues her pregnancy.

But this pro-choice majority has long been opposed by vocal anti-abortion groups, such as the London-based Society for the Protection of Unborn Children, founded in 1966. And now U.S. anti-choice groups have expanded into the U.K., bringing more aggressive tactics that overshadow the homegrown movement.

One such organization is 40 Days for Life, founded in College Station, Texas, in 2004. The group’s self-proclaimed tactic is what they call peaceful prayer outside abortion clinics. (Its name refers to the length of the biannual vigils the group conducts.) However, employees of the British Pregnancy Advisory Service have reported that members of one vigil approached women attending the Bedford Square in London clinic. The Guardian has also reported that clinic workers accused 40 Days activists of filming people entering the clinics.

A second group, Abort67, is the English offspring of the Center for Bio-Ethical Reform, an anti-choice lobby group with headquarters in Lake Forest, Calif. The group, founded by Greg Cunningham, a former advisor to President Ronald Reagan, has more extreme tactics than 40 Days. Primarily active in Brighton and London, they display graphic images of late-term fetuses outside clinics in protest.

This type of graphic protest, fairly uncommon among British anti-choice groups, has proven to be an effective scare tactic. A rape victim, who walked through a protest by Abort67 to enter an abortion clinic, told her local paper it left her feeling “intimidated… panicky and judged.”

Website Hacking

Beyond protests, the criminal hacking of an abortion provider’s website here also had U.S. ties. In April, James Jeffrey was convicted of attacking a British Pregnancy Advisory Service website and stealing the personal information of 10,000 women who had registered with the site. He was also convicted of vandalizing the site with slogans referring to the “abortion industry,” a term with roots in U.S. anti-abortion rhetoric.

Following Jeffrey’s conviction, the BBC reported 2,500 attempts to hack the British Pregnancy Advisory Service’s website again, with more than half of those attacks originating in the United States.

Parliamentary efforts are also taking a harder anti-choice line. Conservative Member of Parliament for Mid-Bedfordshire Nadine Dorries has twice attempted to introduce legislation to lower the legal limit for abortion in the U.K. to 21 weeks from 24 weeks.

After these attempts failed, Dorries began casting aspersion on abortion providers. She criticized counseling provided by clinics as “biased” during a parliamentary debate on National Health Service practices in September last year.

The charge – common in the U.S. anti-choice movement – implied that providers were financially motivated profiteers. It has since gained currency within mainstream right-wing papers in the U.K., such as the Daily Mail and the Daily Telegraph.

This is despite the fact that the vast majority of U.K. abortions are provided either by not-for-profit bodies (mostly Marie Stopes and the British Pregnancy Advisory Service) on behalf of the National Health Service, or by the National Health Service itself. Just 4 percent of abortions are privately funded, according to the Department of Health.

Committee Established

Although Dorries’ amendment was defeated, Anne Milton, the parliamentarian under secretary of state for health, said during the September debate that she was sympathetic to Dorries’ aims. She established a committee to discuss the possibility of independent abortion counseling. Dorries is on that committee, which was due to submit a report at the end of April that hasn’t been published yet.

Pro-choice M.P. Diane Abbott resigned from the committee in January, calling it a front for anti-abortion ideology.

In the face of these attacks, U.K. pro-choice activists are becoming increasingly organized. In Brighton and London, where 40 Days for Life has been most active, an initiative called “40 Days of Treats” delivered cakes and biscuits to the affected clinics for every day of the 40 Days for Life’s vigil.

When the Society for the Protection of the Unborn Child held roadside vigils to mark the anniversary of the 1967 abortion act–which legalized abortion in cases where a woman’s health or life is at risk or if a child is likely to be born with a serious mental or physical disability–pro-choice activists throughout the U.K. held counter-protests.

On May 16, a pro-choice parliamentary meeting organized by the Abortion Rights Campaign brought activists, journalists, abortion providers and parliamentarians together to discuss how best to resist attacks on the right to choose.

But these groups are now clearly on the defensive.

In March, Health Secretary Andrew Lansley ordered inspections of every abortion clinic in the U.K., following a sting operation by the Telegraph newspaper. Doctors who provide abortions say this has left them feeling attacked and demoralized.

Clare Murphy, head of public policy at the British Pregnancy Advisory Service, said in an article for the Independent in March that there is a worrying possibility that doctors will be deterred from training to perform abortions at all.

Sarah Ditum lives in Bath, England. She is a freelance journalist on politics, family and health.

Great article about the blind spots and prejudices on abortion research

Why don’t we know more about the long-term effects of abortion?

Though abortion is one of the most contested medical practices in U.S. history, we know shockingly little about how this simple outpatient procedure affects women. There are almost no scientific studies on what happens to women who receive abortions, and even fewer on what happens to women who are unable to get them. The American government regulates access to abortion, but rarely funds studies on the procedure through the National Institutes of Health (NIH) or the Centers for Disease Control (CDC). That means that most abortion policies in the U.S. are not based on scientific evidence from medical studies.

To find out why, we talked to the University of California at San Francisco’s Tracy Weitz, who for the past decade has run a program at UCSF called Advancing New Standards in Reproductive Health (ANSIRH). The group, funded entirely by private donors, has done some of the only comprehensive studies in the U.S. about abortion in the medical system. Weitz told us what she and her colleagues have found.

ANSIRH was founded at the medical school in 2002 for scientists and doctors who wanted to research abortion and other reproductive health issues. They publish all their results specifically to help policy makers base regulations on rigorous, scientific studies.

The worst study ever done on abortion

In several states, including Kansas, Michigan, Nebraska, North Carolina, South Dakota, Texas, Utah and West Virginia, “informed consent” laws require health care providers to tell women seeking an abortion that the procedure can lead to mental illness. These laws are based in part on a 2009 study by psychology researcher Priscilla Coleman, who found a higher incidence of depression and other psychological disorders among women who had abortions.

Since that time, many scientists — including Weitz herself — have published papers showing how Coleman’s research methods were flawed. She made the basic “correlation equals causation” error, said Weitz. “You may have higher rates of depression in the population of women who choose abortion, but that’s part of why they choose abortion. You can’t make a causality argument, but that’s what these studies try to do.”

To combat poorly-designed studies like Coleman’s, ANSIRH has just completed a five-year study on the long-term health effects of abortion on women. They’re currently analyzing their data, and will have results to report later this year.

There are no studies on what happens to women’s health when they want abortions but are denied them. Weitz says that’s partly because gathering that data would be almost impossible. Women can be denied abortions in multiple ways. “It could be health care providers denying it to them,” she said, or it could be that they go to an abortion clinic but their pregnancies are so far along that the clinic says it can’t handle the procedure.

“The only way to do it would be to track a general population and ask them what their experience was when they sought abortions,” she mused. But even that would be difficult, because often women aren’t willing to admit they wanted abortions. Besides, Weitz added, women’s perspectives on unwanted pregnancies change once they’ve actually had their children. “It was unintended, they didn’t want it, but then the child is there and they love their children,” she said. It would be hard to ask women in that position about having an unwanted child, since they have ultimately come to want it.

“Another question we’re interested in is how many women don’t even contemplate an abortion because the social stigma is so great in their communities,” Weitz said. “If they lived in a different world, would they have had an abortion?” Again, this is a question that’s almost impossible to answer.

But there is one data set that gives us hard numbers on how much social environment affects whether women will get an abortion.

How many unwanted babies are born when abortion is taken away?

In North Carolina, researchers can track very precisely what happens to women when access to abortion is taken away. That state separates medicaid funds for abortion into its own special fund, and the fund has been cut off at various points over the years. So researchers can pore over data that shows how many abortions women get when money is available for them versus when it isn’t. For many women, coming up with $500 to get an abortion in time (ideally, the first 3 months of pregnancy) is impossible. So lack of funding means lack of access, period.

In a scientific analysis of the data, researchers found that “3 out of 10 pregnancies that would have been terminated were carried to term among low income black women” who were the main recipients of the medicaid funds. Those are fairly extraordinary numbers. They suggest that 3 out of 10 women who were already struggling financially are now saddled with the additional expense of rearing children.

Questions around how abortion should be funded are part of a larger issue: How does abortion fit into the medical system? This sounds like an odd question, but it’s what doctors have to ask about any procedure that’s more complicated than taking your blood pressure. Who can do the procedure, and under what conditions? Is abortion such a difficult medical undertaking that it needs to be done by a specialist at an abortion clinic? Currently, most states say yes. In California, for example, only doctors are allowed to perform abortions and most often they’re done at specialized clinics.

Placing all these limitations on who can do abortions and where means that women often don’t have access to abortions in time. As Weitz put it, every week that a woman waits to get an abortion — whether because she needs a doctor’s appointment, is raising $500, or has to travel to a far-away clinic — makes the operation more difficult.

But what if women could get safe abortions in their primary doctor’s offices, from nurse practitioners? This would certainly help women get abortions in time far more often. ANSIRH did a 4-year study in California asking this very question. They gathered data on the feasibility of training physicians, nurse practitioners, and even midwives to conduct abortions. As a health service, Weitz explained, abortions are relatively simple — from a purely medical standpoint, a first term abortion is roughly equivalent to having your wisdom teeth pulled. ANSIRH’s researchers found that a variety of healthcare providers could be trained relatively quickly to provide abortions, and that this would be a very cost-effective way to provide safer abortions to a greater number of women. Their research is currently being used by policy makers in California to evaluate a law that allows a greater range of clinicians to give abortions.

What should scientists really be researching if they want to understand how abortion affects women?

Weitz has spent much of her career researching questions that most scientists and funding organizations won’t touch. But there is a lot more she’d like to know.

“I think the real question of interest is what social and economic resources do women need to make the child bearing decisions they want,” she said. She continued:

Some women don’t want to be pregnant because it’s not the right time in their lives, and that’s a very affirmative decision. Then there are women [at abortion clinics] because they don’t have enough money, they don’t have a place to live. Those women are not making an affirmative choice — they’re making a survival choice. [In the context of social justice] we need to be asking more than, “Did they get the abortion?” but “What kinds of policies could be in place to help women make the decision they truly want?” We’ve forgotten to think about that group of women because this is so politicized. But what would allow women to make a genuine choice, to have the families they want and to parent their kids in healthy communities? In a rational society, that’s what we’d be asking.

Weitz gets to the heart of what “choice” really means for women. In our current political climate, pundits lump “choice” in with “abortion.” But understood rationally, as Weitz would have it, choice means setting up a social system where women never have to terminate pregnancies for survival reasons. They shouldn’t fear living on the streets, without resources, just because they want children.

One of the greatest investments women make, both financially and emotionally, is in their kids. But we live in a nation that provides almost no assistance to low-income women who want to be mothers. As long as this is the case, women will never truly be making a free choice about whether to give birth.